7.8 Palliative Care (Plan P)

Coverage is for B.C. residents of any age with active MSP coverage who:

• Are living in their own home; with family or friends; in a supportive or assisted living residence; or in a hospice unit in a long-term care facility (e.g., a community hospice bed not covered under PharmaCare Plan B)
• Have been diagnosed with a life-threatening illness or condition
• Have a life expectancy of up to six months, and
• Consent to the focus of care being palliative rather than treatment aimed at a cure

Coverage does not extend to patients in acute care.

A physician or nurse practitioner registers people for the BC Palliative Care Benefits program.

In some instances, PharmaCare may extend coverage to Canadian citizens/permanent residents who are new B.C. residents and do not yet have MSP coverage.

 

Plan P coverage begins as soon as HIBC processes the registration and enters the information in PharmaNet.

Physicians and nurse practitioners must reassess the patient's eligibility at 12 months.

Plan P coverage cannot be provided retroactively.

Plan P provides 100% coverage of the costs of prescription and over-the-counter (OTC) drugs listed in the Plan P formulary and dispensing fees, up to the maximum drug cost and dispensing fee recognized by PharmaCare.

PharmaCare’s Full Payment Policy applies to Plan P.

Plan P covers:

• Prescription medications or OTC drugs prescribed for pain, symptom control and improved quality of life, and
• Certain OTC drugs required to supplement the prescription drugs and considered to be medically necessary for palliative care

For coverage of an OTC drug in the Plan P formulary, a prescriber must write a prescription for the drug and the pharmacy must enter the drug in PharmaNet system.

Note: Needles and syringes for administration of injectable medications are provided by the health authorities as medical supplies and equipment benefits.

Products not covered under Plan P automatically adjudicate under the patient’s primary PharmaCare plan (e.g., Fair PharmaCare, Plan C,  Plan W, Plan F). Patients should register for the Fair PharmaCare plan if they are not covered under another primary plan.

Special Authority coverage

Under specific circumstances, PharmaCare will consider a request for Special Authority coverage under Plan P of a drug that is not included in the Plan P formulary. Prescribers can submit a request if:

• The drug is needed to alleviate patient discomfort, and
• The drug is not covered under another PharmaCare plan, and
• There is no substitute for the drug in the Plan P formulary

To apply for Special Authority coverage:

1. A physician or nurse practitioner submits the General Special Authority Request eForm online (quicker) or faxes HLTH 5328 - General Special Authority Request Form (PDF, 656KB).
2. The prescriber should clearly mark “for palliative care registrant” on the request form so that it receives priority attention.

People who are not eligible for the Palliative Care Benefits program may be eligible for palliative medication coverage by government insurers such as Veterans Affairs Canada, or by private insurers.

Individuals covered by the Non-Insured Health Benefits (NIHB) Program of Health Canada or Veterans Affairs Canada (VAC) may receive medication coverage under Plan P only if the medication is not covered by NIHB or VAC.

Members of the Canadian Forces receive coverage through their employers and are therefore not eligible for Plan P coverage.

New B.C. residents

Plan P coverage is available to new B.C. residents who have not yet qualified for MSP. Patients do not need active MSP coverage but do require a Personal Health Number (PHN). A PHN can be assigned at any B.C. community pharmacy. Plan P patients without MSP must pay for their prescribed palliative medications and then submit the receipts to PharmaCare for reimbursement.

A physician or nurse practitioner registers individuals for the Palliative Care Benefits program using the HLTH 349 - BC Palliative Care Benefits Registration form (PDF, 389KB).

1. Confirm indicators of poor and deteriorating health and a life-limiting condition(s) in the Supportive and Palliative Care Indicators Tool (SPICT™) section of the form.
2. The patient or a legal representative must sign the registration form. If a patient is unable to sign and has no legal representative, a physician or nurse practitioner may act on the patient’s behalf. For a new B.C. resident not yet enrolled in MSP, use a PHN created by a pharmacist.
3. Fax copies of the completed form to PharmaCare and to the local health authority (for assessment for medical supplies and equipment).
4. The form is usually processed within 12 hours. Once the registration is processed, prescriptions can be filled at nearly any pharmacy in B.C.

Pharmacists can contact the PharmaNet Help Desk to confirm enrolment.

Physicians and nurse practitioners can call the 24/7 toll-free Palliative Care Coverage Confirmation Line, staffed by palliative care physicians who provide a palliative care consultation, 1-877-711-5757. 

For a new B.C. resident not yet enrolled in MSP, the registering physician or nurse practitioner will receive a Confirmation of Coverage letter to share with the patient. The letter explains they should obtain MSP coverage as soon as they qualify.

For information about medical supplies and equipment, contact the Home and Community Care (HCC) office of your local health authority. Contact information may be obtained by calling 8-1-1 or by searching “home and community care” at HealthLinkBC.